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The efficacy of an online intervention aimed at enhancing approach motivation and behavioral engagement in confronting anxiety-inducing social situations is examined among individuals with elevated social anxiety. Participants will receive psychoeducation, followed by either a prospective mental-imagery task or a verbal reasoning task. Efficacy of the intervention is measured by ratings of experienced and anticipated pleasure, approach motivation and self-reported engagement with feared situations one week later.
With numerous studies demonstrating its long-term effectiveness, exposure therapy is currently considered the leading evidence-based treatment for anxiety disorders. However, a major limitation in its application is that patients often discontinue treatment due to their unwillingness to confront themselves with the feared situation. Considering that targeting avoidance behaviors and maladaptive fear responses are at the core of exposure therapy, strategies are needed to enhance both approach motivation as well as behavioral engagement with the feared situation. Among individuals with depression, prospective mental imagery has been demonstrated to increase motivation and behavioral engagement in pleasurable activities by elevating anticipated reward as well as anticipatory and anticipated pleasure ('motivational amplifier' hypothesis). Given alterations in motivational and reward processes in individuals with social anxiety, prospective mental imagery may enhance reward anticipation and facilitate approach motivation and engagement in exposure to socially feared situations. The current online study will compare the use of a prospective mental-imagery task to an active control group (verbal reasoning) in improving approach motivation and behavioral engagement with feared situations in individuals with heightened social anxiety. Participants in both conditions will receive psychoeducation. Participants in the experimental group will vividly imagine themselves successfully mastering the feared social situation. Participants in the control condition are asked to reflect on the pros and cons of confronting themselves with the feared social situation. Approach motivation as well as reward anticipation, anticipated and anticipatory pleasure will be assessed before and after the imagery or verbal reasoning task. Engagement with the feared social situation will be assessed one week later. Aim of the randomized controlled trial is to investigate whether prospective mental imagery is effective in enhancing self-reported motivation and engagement with feared situations compared to an active control group. In an exploratory analysis, we will examine whether the efficacy of the prospective imagery training is modulated by individuals' levels of reward sensitivity and anhedonia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Psychoeducation + Prospective Mental-Imagery Task | Experimental | Prospective mental imagery of post-exposure experience |
|
| Psychoeducation + Verbal Reasoning Task | Active Comparator | Verbal reasoning of pro and cons of exposure |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Psychoeducation | Behavioral | Providing information about social anxiety, role of safety and avoidance behaviors in maintaining social anxiety, rationale for exposure to feared social situations |
| Measure | Description | Time Frame |
|---|---|---|
| Anticipatory Pleasure | 2-item questionnaire on a scale 0 (not at all) to 100 (extremely) assessing current pleasure when imaging approaching and having approached the feared situations. | Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task) |
| Anticipated Pleasure | 2-item questionnaire on a scale 0 (not at all) to 100 (extremely) assessing expected pleasure when approaching and having approached the feared situations. | Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task) |
| Reward Anticipation | 2-item questionnaire on a scale 0 (not at all) to 100 (extremely) assessing expected reward related to approaching and having approached the feared situations. | Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task) |
| Motivation | Self-reported motivation to approach the feared situations on a scale of 0 (not at all) to 100 (extremely). | Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task) |
| Frequency of Exposure | Self-reported frequency of exposure to the feared situations. | Post-treatment (i.e., 7 days after baseline) |
| Measure | Description | Time Frame |
|---|---|---|
| Social Phobia Inventory (SPIN) | 17-item questionnaire on a 5-point Likert scale (0 = 'not at all'; 4 = 'extremely') assessing symptom severity related to social anxiety (i.e., fear, avoidance, physical symptoms). Total range score: 0 to 68. Higher scores indicating greater severity of social anxiety. | Change from baseline to post-treatment (i.e., 7 days) |
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Inclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Germany Philipps University | Marburg | 35037 | Germany |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 32551746 | Background | Hallford DJ, Farrell H, Lynch E. Increasing anticipated and anticipatory pleasure through episodic thinking. Emotion. 2022 Jun;22(4):690-700. doi: 10.1037/emo0000765. Epub 2020 Jun 18. | |
| 36397959 | Background | Renner F, Werthmann J, Paetsch A, Bar HE, Heise M, Bruijniks SJE. Prospective Mental Imagery in Depression: Impact on Reward Processing and Reward-Motivated Behaviour. Clin Psychol Eur. 2021 Jun 18;3(2):e3013. doi: 10.32872/cpe.3013. eCollection 2021 Jun. |
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| ID | Term |
|---|---|
| D000072861 | Phobia, Social |
| ID | Term |
|---|---|
| D010698 | Phobic Disorders |
| D001008 | Anxiety Disorders |
| D001523 | Mental Disorders |
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| Prospective Mental Imagery | Behavioral | A standard imagination script is recounted in which participants have successfully mastered the socially feared situation |
|
| Verbal Reasoning | Behavioral | Participants are asked to reflect on the pros and cons of facing the socially feared situation |
|
| Mood State Questionnaire | 6-item assessment using a 7-point bipolar Likert scale to measure a person's current mood across three dimensions: energetic arousal, valence, and calmness. Higher scores indicating higher energetic arousal, more positive valence, and greater calmness. | Baseline (prior to the assigned intervention) and immediately post-intervention (following the prospective mental imagery or verbal reasoning task) |
| Liebowitz Social Anxiety Scale (LSAS) | 24-item questionnaire on a 4-point Likert scale (fear: 0 = 'none'; 3 = 'severe'; avoidance: 0 = 'never'; 3 = 'usually') assessing both fear/anxiety and avoidance of social situations, respectively. Total range score: 0 to 144. Higher scores indicating greater fear and avoidance as well as severity of social anxiety. | Change from baseline to post-treatment (i.e., 7 days) |
| Patient Health Questionnaire-9 (PHQ-9) | 9-item questionnaire on a 4-point Likert scale (0 = 'not at all'; 3 = 'nearly every day') assessing the presence and severity of depressive symptoms. Total range score: 0 to 27. Higher scores indicating more severe depression. | Baseline |
| Positive and Negative Affect Schedule (PANAS) | 20-item questionnaire on a 5-point Likert scale (0 = 'not at all'; 4 = 'extremely') assessing the presence and intensity of both positive and negative emotions. Total score range for positive affect (PA) and negative affect (NA), respectively: 0 to 50. Higher scores indicate on either scale indicate a higher level of that emotion. | Baseline |
| Snaith-Hamilton-Pleasure-Scale (SHAPS) | 14-item questionnaire on a 4-point Likert scale (0 = 'strongly disagree'; 3 = 'strongly agree') measuring anhedonia. Total score range: 0 to 42. Higher total scores indicate greater levels of anhedonia. | Baseline |
| Positive Valence System Scale (PVSS-21) | 21-item questionnaire on a 9-point Likert scale (1= 'extremely untrue of me'; 9 = 'extremely true of me') assessing an individual's response to various types of rewards in daily life. Total score range: 21 to 105. Higher scores indicating a greater tendency to experience pleasure and respond to rewards. | Baseline |
| Vividness of Mental Imagination | Vividness of imagination on a scale from 0 (not at all) to 100 (extremely vivid) assessed immediately after prospective mental-imagery and verbal reasoning task. | Immediately after assigned interventions (prospective mental imagery and verbal reasoning task) at baseline |
| Verbal Reasoning | Intensity of reflection on the pros and cons of seeking out the feared situation on a scale from (not intensive at all) to 100 (extremely intensive) assessed after prospective mental-imagery and verbal reasoning task. | Immediately after assigned interventions (prospective mental imagery and verbal reasoning task) at baseline |
| 30797989 | Background | Renner F, Murphy FC, Ji JL, Manly T, Holmes EA. Mental imagery as a "motivational amplifier" to promote activities. Behav Res Ther. 2019 Mar;114:51-59. doi: 10.1016/j.brat.2019.02.002. Epub 2019 Feb 5. |
| 34433114 | Background | Ji JL, Geiles D, Saulsman LM. Mental imagery-based episodic simulation amplifies motivation and behavioural engagement in planned reward activities. Behav Res Ther. 2021 Oct;145:103947. doi: 10.1016/j.brat.2021.103947. Epub 2021 Aug 15. |